With new contracts awarded to Medicaid MCOs, lawmakers talk potential cost-sharing options

09/16/2015 07:19 PM

FRANKFORT — Kentucky’s five Medicaid managed care organizations are under new contracts to improve efficiencies, but one Republican lawmaker wants recipients to have more “skin in the game” through co-payments and deductibles.

The Medicaid Oversight and Advisory Committee reviewed changes in contracts that took effect in July between the state and MCOs Anthem, Humana, CoventryCares, WellCare and Passport on Wednesday before the discussion turned to out-of-pocket payments for Medicaid recipients.

Rep. Robert Benvenuti, R-Lexington, proposed setting a small co-payment or deductible on Medicaid benefits provided by MCOs, specifically mentioning a “shrinking deductible” that rewards healthy behavior.

“I hear that though the MCOs can, are able to contractually have co-pays and deductibles, for example, but they don’t because it’s a competition thing,” he said, “and if somebody puts in a $10 co-pay or a $5 co-pay, they’re afraid that they’re going to lose covered lives and the covered lives are going to switch to another MCO.

“And it would just seem to me that that ought to be mandated in these contracts. We’ve got to have folks to have skin in the game.”

Such cost-sharing provisions wouldn’t affect everyone in the program, which has been expanded via executive order by Gov. Steve Beshear under the Affordable Care Act.

The U.S. Centers for Medicare and Medicaid Services exempt emergency services, family planning, pregnancy-related services and preventative services from children from out-of-pocket expenses. Specific groups like children younger than 18, institutionalized persons and those receiving hospice care are also free from such costs.

While she said she would be “open to talking about” Medicaid cost-sharing options, Rep. Joni Jenkins said policymakers should be mindful of those indigent Kentuckians who rely on the program for health care if such a proposal is considered.

“I think we need to remember what this population looks like and what the income requirements are to be eligible for that,” the Shively Democrat said.

Kentucky went to a managed care system as it grappled with operational costs in the Medicaid program, and Commissioner Lisa Lee of the Department for Medicaid Services said a cost-sharing plan could be an option to help curb expenses.

“I think as a group we just need to come together and figure out what we can do to make this program sustainable going forward and look at every option on the table, put everything out there and try to see what we can do,” Lee said.

“And of course we know that we have a new administration coming in next year, and we’ll have opportunities to kind of look at the program and how to best move forward to make sure that we are providing services and being fiscally responsible.”

Rep. David Watkins, D-Henderson, suggested indirect charges to help promote healthier behavior, such as raising the prices of cigarettes and other tobacco products as well as a greater emphasis on educating Medicaid recipients on how to properly utilize their benefits.

“As a provider one of the things that always worried me in dealing with our managed care and dealing with Medicaid was that we a lot of times provide to the least sophisticated individuals a credit card that enables them to seek health care at no expense, so this is truly somewhat of a worry,” he said.


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